PhilHealth Citizen's Charter 2013

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Submission of application for engagement of Health Care Providers (HCPs). 26. 7. Filing of claims. 32. 8. ..... hospital
PhilHealth Citizen’s Charter (PCC) 2013 (modified as of November 2013) Table of Contents Title

Page

A.

Vision

3

B.

Mission

3

C.

Values

3

D.

Panunumpa sa Serbisyo

3

E.

Frontline Services Offered and Clientele

F.

4-37

1.

Registration

2.

Enrollment (IPM/Overseas Workers)

10

3.

Payment of premium contributions

14

4.

Inquiry

17

5.

Updating of records

17

6.

Submission of application for engagement of Health Care Providers (HCPs)

26

7.

Filing of claims

32

8.

Submission of reports (manual)

36

9.

Request for records

37

10.

Check releasing

37

Matrix of Service Standards (for frontline services)

4

38-53

1. Membership registration (Employer/Employee/Lifetime Member)

38

2. Membership enrollment (All Member Types)

41

3. Updating of membership records

43

4. Request for records (MDR/Certificates/PIC/CE1)

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Title

Page

5. Payment of premium contributions

45

6. Inquiry/public assistance

46

7. Filing of claims by IHCPs

46

8. Filing of claims (Direct-filing by members)

47

9. Submission of remittance reports (RF1)

48

10. Submission of application for accreditation by Health Care Institutions

48

11. Submission of application for engagement of Health Care Professionals

49

12. Check releasing (pick-up by member)

51

13. Check releasing (pick-up by stakeholders)

51

14. Request for other services

52

15. Feedback mechanism

53

G.

Process Flow Chart

54

H.

Feedback and Redress Mechanism

I.

Anti-fixer Campaign Banner

57

J.

Anti-fixer Campaign Calling Card

58

55-56

Table 1. Premium Contribution Table for the Formal Economy including sea-based employees and Kasambahay

Annex A

Table 2. Premium Contribution Table for the Informal Economy /Sponsored Members

Annex B

Table 3. Premium Contribution Table for Migrant Workers

Annex B

Table 4. Schedule of Accreditation Fee for Health Care Institutions

Annex C

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A.

Vision

Bawa’t Pilipino Miyembro, Bawat Miyembro, Protektado, Kalusugan Natin, Segurado

B.

Mission

Sulit na Benepisyo sa Bawat Miyembro, Dekalidad na Serbisyo para sa Lahat

D.

Values I-nnovation Q-uality Service U-tmost Integrity E-quity S-ocial Solidarity & T-otal Care

C.

Panunumpa sa Serbisyo

Kami ay nangangakong ilalaan ang mga sarili sa pagsasakatuparan ng Kalusugang Pangkalahatan. Sisikapin naming makapagbigay nang mabilis at de kalidad na serbisyong pangkalusugan sa lahat ng Pilipino, ano man ang edad, kasarian o estado ng pamumuhay. Kaagapay namin ang mga miyembro sa pagtataguyod ng panlipunang pagkakaisa bilang isang konseptong mahalaga sa pagkamit ng aming layunin. Patuloy naming paghuhusayin ang aming mga serbisyo at titiyaking ang mga ito’y umaayon sa nagbabagong panahon at sumasabay sa pandaigdigang pamantayan. Titiyakin naming laging mauuna ang serbisyo-publiko at taas noo na maglilingkod sa bayan. Sisikapin naming maging huwarang kawani at makamit ang tunay na pagbabago sa ating bansa.

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E. Frontline Services Offered and Clientele 1. Registration (Formal Economy, Employee, Lifetime) Frontline Services &



Documentary Requirements

PhilHealth Forms

Fee/s

Duration

Clientele 1.1 Formal Economy 1.1.1 Government

NONE

• No service fee

• 10 minutes

• No service fee

Within the day

• No service fee

• 15 minutes

Record(ER1) Form

sector

1.1.2 Private Sector

• Employer Data

A. For employers enrolling thru the Philippine Business Registry (PBR) • NONE B. Non-PBR • Business permit/license to operate and/or any of the following: a) Department of Trade and Industry (DTI) Registration (for single proprietorship) b) Securities and Exchange Commission (SEC) Registration (for partnerships, corporations, foundations, & non-profit organizations) c) Cooperative Development Authority (CDA) Registration (for cooperatives) d) Barangay Certification and/or Mayor’s Permit (for backyard industries/ventures and micro-business enterprises)

• PBR Form

• ER1 Form

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Frontline Services &



Documentary Requirements

PhilHealth Forms

Fee/s

Duration

Clientele 1.1.3 Employer Government and Private) User of Electronic Premium Reporting System (EPRS) registration

Manual Submission • None

Electronic Submission • None

1.2 Employee 1.2.1 For newly hired and existing employees without PIN yet

• None

• PhilHealth Online Access Form (POAF)

• No service fee

• 5 working days (registration)

• Electronic PhilHealth Online Access Form (e-POAF)

• No service fee

• 5 working days (registration)

• PMRF • ER2

• No service fee

• 20 minutes (for 5 PMRFs and below) • 10 working days (for 6 PMRFs and Above)

1.3 Lifetime Membership Program



2 latest 1x1 ID photo



Specimen signature

• PMRF

• No service fee

• 20 minutes

General requirements for all categories of retirees

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Frontline Services &



Documentary Requirements

PhilHealth Forms

Fee/s

Duration

Clientele Specific requirements per category 1.3.1 SSS retirees/ pensioners

1.3.2 GSIS retirees

• Printout of Death, Disability and Retirement (DDR) from any SSS office indicating that the type of claim is retirement in nature and the effectivity date of pension; or • Printout of contributions issued by SSS office indicating the latest contributions (if they retired after March 4,1995)

• PMRF

• No service fee

• 20 minutes



• PMRF

• No service fee

• 20 minutes

• No service fee

• 20 minutes

Any of the following:  Certification/Letter of Approval of Retirement from GSIS  Service Record issued by employer/s indicating date of retirement and total number of service not less than 120 months  Certification/Retirement Gratuity from employer indicating not less than 120 months of service.

1.3.3 AFP, PNP and BFP Retirees/ Pensioners • Any of the following: • PMRF (those who are inactive  Statement of Services from previous employer military service until indicating not less than 120 months of service they retire at age 56 and  Certification/Letter of Approval of Retirement from those separated by GSIS not less than 120 months of service retirement or other reasons prior to the said  General, Bureau or Special Order indicating effectivity of retirement. age but have reached the age of 60)

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Frontline Services &



Documentary Requirements

PhilHealth Forms

Fee/s

Duration

Clientele 1.3.4 Retiring employees whose application for the Lifetime Member Program (LMP) will be facilitated by the employer three (3) months prior to the date of retirement

• Photocopy of the following documents, duly certified

• PMRF

• No service fee

• 3 minutes

by the employer: Approved retirement application and proof of contributions or Service Record

1.4 Members Declaration None of Dependents If warranted - Case to Case basis but not limited to the following:

• PMRF

• No service fee

(Part of registration under 1.2)

a) Spouse • Marriage Certificate/Contract with registry number • For marriage which took place abroad, marriage certificate stamped “Received” by the Philippine Embassy or consular office exercising jurisdiction over the place of marriage b) Muslim Spouse • Affidavit of Marriage issued by the Office of Muslim Affairs (OMA), which passed through the Shari’a Courtand must be registered/authenticated in the National Statistics Office (NSO)

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Frontline Services &



Documentary Requirements

PhilHealth Forms

Fee/s

Duration

Clientele c) Legitimate or illegitimate children below 21 years old • Birth Certificate with registry number or Baptismal Certificate reflecting the name of the member as parent • For births which took place abroad, Birth Certificate Stamped “received” by the Philippine embassy or Consular office exercising jurisdiction over the place of birth d) Adopted children below 21 years old • Court Decree/Resolution of Adoption or Birth Certificate of the adopted child/ren in which adoption is annotated thereto e) Stepchildren below 21 years old • Marriage Certificate (with registry number) between biological parents and step father/stepmother and Birth Certificate/s (with registry number) of the stepchildren f) Mentally or physically disabled children who are 21 years old and above • Birth Certificate and original Medical Certificate issued by the attending physician within the past 6 months stating and describing the extent of disability

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Frontline Services &



Documentary Requirements

PhilHealth Forms

Fee/s

Duration

Clientele g) Parent/s 60 years old and above • Birth Certificate with registry number of both registrant and parent (in the absence of Birth Certificate of parent, any proof attesting to the date of birth of parent/s) h) Step parents 60 years old and above • Marriage Certificate/Contract with registry number between biological parent of the member-child and the stepparent; • Birth Certificate of the stepparent (in its absence, a notarized affidavit of 2 disinterested persons attesting to the date of birth); • Birth Certificate of the member-child indicating the name of his/her biological parent; and • Death Certificate of member’s deceased biological parent i) Adoptive parents 60 years old and above • Court Decree/Resolution of Adoption or photocopy of Birth Certificate o f the child in which the adoption is annotated thereto; and • Birth Certificate/s of adoptive parents or in its absence, a notarized affidavit of 2 disinterested persons attesting to the date of birth j) Foster Child • Foster Placement Authority from DSWD

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Frontline Services &



Documentary Requirements

PhilHealth Forms

Fee/s

Duration

Clientele Parents with permanent disability totally dependent with member • Original Medical Certificate issued by the attending physician within the past 6 months stating and describing the extent of disability

2. Enrollment Frontline Services & Clientele

Documentary Requirements

PhilHealth Forms

Fees/s

Duration

2.1 Informal Economy 2.1.1 Informal Sector (formerly known a s Individually Paying Member) 2.1.2 i-Group (Organized Group)

• None

• PMRF

• No service fee

• 5 minutes

• Signed MOA

• PMRF

• No service fee

• 10 minutes

• Applicable Certification from BSP, COA, SEC, DTI &

• IPAF

LGU

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Frontline Services & Clientele 2.1.3 Migrant Workers (landbased)

2.1.4 Foreign Nationals

Documentary Requirements • None

PhilHealth Forms

Fees/s

Duration

• PMRF

• No service fee

• 5 minutes

• PMRF

• No service fee

• 5 minutes

If warranted: • Any of the following as proof of being an active OFW:  Valid Overseas Employment Certificate (OEC) or Ereceipt of current year or is valid for one (1) year from date of transaction; or  Working Visa/Re-entry Permit; or  Valid Job Employment Contract; or  Certificate of Employment for applicable period from Employer abroad; or  Valid Company ID issued by Employer abroad; or  Cash Remittance receipt from member abroad at least 2 months prior to the date of renewal/payment; or  Valid workers' Identification (ID) Card issued bythe host country (i.e.Hongkong ID,Iqama of Saudi, Permessod' Soggiorno and Cartad'Identita of Italy);or  Any other equivalent document that will prove that the member is an active OFW.  Valid workers' Identification (ID) Card issued by the host country (i.e.Hongkong ID,Iqama of Saudi, Permessod' Soggiorno and Cartad'Identita of Italy);or  Any other equivalent document that will prove that the member is an active OFW. • Alien Certificate Registration (ACR)

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Frontline Services & Clientele 2.2 Members Declaration of Dependents

Documentary Requirements

None If warranted - Case to Case basis but not limited to the following:

PhilHealth Forms

• PMRF

Fees/s

• No service fee

Duration

(Part of registration under 2.1)

a) Spouse • Marriage Certificate/Contract with registry number • For marriage which took place abroad, marriage certificate stamped “Received” by the Philippine Embassy or consular office exercising jurisdiction over the place of marriage b) Muslim Spouse • Affidavit of Marriage issued by the Office of Muslim Affairs (OMA), which passed through the Shari’a Courtand must be registered/authenticated in the National Statistics Office (NSO) c) Legitimate or illegitimate children below 21 years old • Birth Certificate with registry number or Baptismal Certificate reflecting the name of the member as parent • For births which took place abroad, Birth Certificate Stamped “received” by the Philippine embassy or Consular office exercising jurisdiction over the place of birth d) Adopted children below 21 years old • Court Decree/Resolution of Adoption or Birth Certificate of the adopted child/ren in which adoption is annotated thereto 12 | P a g e

Frontline Services & Clientele

Documentary Requirements

PhilHealth Forms

Fees/s

Duration

e) Stepchildren below 21 years old • Marriage Certificate (with registry number) between biological parents and stepfather/stepmother and Birth Certificate/s (with registry number) of the stepchildren

f) Mentally or physically disabled children who are 21 years old and above • Birth Certificate and original Medical Certificate issued by the attending physician within the past 6 Months stating and describing the extent of disability g) Parent/s 60 years old and above • Birth Certificate with registry number of both registrant and parent (in the absence of Birth Certificate of parent, any proof attesting to the date of birth of parent/s) h) Step parents 60 years old and above • Marriage Certificate/Contract with registry number between biological parent of the member-child and the stepparent; • Birth Certificate of the stepparent (in its absence, a notarized affidavit of 2 disinterested persons attesting to the date of birth); • Birth Certificate of the member-child indicating the name of his/her biological parent; and • Death Certificate of member’s deceased biological parent

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Frontline Services & Clientele

Documentary Requirements

PhilHealth Forms

Fees/s

Duration

i) Adoptive parents 60 years old and above • Court Decree/Resolution of Adoption or photocopy of Birth Certificate o f the child in which the adoption is annotated thereto; and • Birth Certificate/s of adoptive parents or in its absence, a notarized affidavit of 2 disinterested Persons attesting to the date of birth j) Foster Child • Foster Placement Authority from DSWD Parents with permanent disability totally dependent with member • Original Medical Certificate issued by the attending physician within the past 6 months stating and describing the extent of disability 2.3 Sponsored Members (LGUs, etc.)

• MOA and OBR • Certified List/PMRF

• PMRF

• No service fee



10 minutes

For declaration of dependents • Same with requirements for declaration of new/additional dependents

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3. Payment of premium contributions (Formal / Informal Economy and Migrant Workers (land-based) Frontline Services & Clientele 3.1 Formal Economy (formerly known as Employed Segment)

Documentary Requirements

3.2.1 Informal Sector (formerly known as Individually Paying Member) 3.2.2 I-Group

Premium Contributions

For EPRS Users: •

EPRS generated Statement of Premium Accounts

For non-EPRS Users:

3.2 Informal Economy

PhilHealthForms

Duration

• 10 minutes •

PhilHealth Premium Payment Slip (PPPS)

PhilHealth Premium Payment Slip (PPPS)

• Refer to schedule of premium contributions in Annex 1



None





None

• PPPS

• Refer to schedule of premium contributions in Annex B, Table 2



Billing statement

• PPPS

• No service fee • Member need to pay per schedule as provided in Annex B, Table 2

• 5 minutes

• 10 minutes

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Frontline Services & Clientele 3.3 Sponsors (LGUs/Legislators)

3.4 Migrant Workers (land-based)

Documentary Requirements

• Billing statement



None

PhilHealthForms

Premium Contributions

Duration

• PPPS

• No service fee • Member need to pay per schedule as provided in Annex B, Table 2

• 10 minutes

• PPPS

• Refer to schedule of premium contributions in Annex B, Table 3

• 5 minutes

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4. Inquiry Frontline Services &

Documentary Requirements

PhilHealth Forms

Fees/s

Duration

Clientele 4.1

General Information - All

• Applicable forms such as PMRF, Claim Forms 1, 2 & 3, ER 1, 2 & 3, Premium Payment Slip • Info materials such as Pamphlets, brochures, flyers



None



Request Letter

Members

4.2

PhilHealth RefundAll Members



None



No service fee



8 minutes



No service fee



10 minutes

5. Updating of records Frontline Services & Clientele 5.1

All members

Documentary Requirements a) For correction of name • • If warranted, Birth certificate or 2 valid IDs with correct name or marriage certificate plus another valid ID with correct name / Affidavit of 2 disinterested persons b) For change of name (PC 50, s-2012) • If warranted, Annulment/Court Decision/Barangay Certificate/NSO with annotation/

PhilHealth Forms PMRF

Fee/s •

No service fee

Duration •

10 minutes

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Frontline Services & Clientele

Documentary Requirements

PhilHealth Forms

Fee/s

Duration

c) Correction of date of birth • If warranted, Birth certificate or 2 valid IDs with correct date of birth or marriage certificate with correct date of birth plus another valid ID with correct date of birth d) Change of civil status • If warranted, Marriage Contract Certificate/Court Decision e) New and additional dependents • None • If warranted, Birth Certificate of the dependent/Court Decision on Adoption/Foster Parental Authority from DSWD/Medical Certificate for parents below 60 years old and children above 21 years old with permanent disability f) Change and correction of information of dependent/s •

Birth Certificate of the dependent/Court Decision on Adoption/Marriage Contract If warranted: Death Certificate of Spouse

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Frontline Services & Clientele 5.2

Documentary Requirements

Employers

5.2.1 Single Proprietorship

a) Correction/change of business name/legal personality • Certificate of Registration of Business Name from Department of Trade and Industry

PhilHealth Forms

• Employer Data Amendment Form (ER3)

Fee/s



No service fee

Duration



10 minutes

b) Temporary suspension of operation due to: • Bankruptcy  Financial Statement; or  Income Tax Return (ITR) • Fire / Demolition –  Certification from the Fire Department of the locality; or  Certification from the Municipal / City Hall • Separation of employee/s –  Report on the Separation of the Last Employee/s; and  Separation paper of the last employee/s • Termination / Dissolution  For single proprietorship - approved application for Business Retirement by the Municipal/City Treasurer’s Office  For partnership or corporation – Deed of Dissolution approved by SEC or minutes of the meeting certified by the Corporate Secretary  For cooperatives – Certificate/Order of Dissolution/Cancellation issued by the CDA  Under fortuitous events as defined by law – applicable supporting documents as may be determined by the Corporation 19 | P a g e

Frontline Services & Clientele

Documentary Requirements

PhilHealth Forms

Fee/s

Duration

d) Change of ownership  Deed of Sale / Transfer / Assignment signed by both parties* e) Resumption of Operation – Prescribed Philhealth Form reporting newly hired or re-hired employees • Death of managing owner (Family Business) –  Death Certificate of the managing owner and waiver from the other legal heirs • Resumption of Operation  Notice of Resumption of Operation from the employer, and List of Employees.

5.2.2 Partnership

a) Correction of business name • Certificate of Registration from Securities Exchange Commission; or Certificate of Articles of Partnership duly approved by Securities Exchange Commission



ER3



No service fee



10 minutes

b) Change of business name • Certificate of Amended Articles of Partnership duly approved by Securities Exchange Commission c) Change of legal personality (Partnership to Corporation) • Certificate of Articles of Incorporation duly approved by Securities Exchange Commission; and • Deed of Dissolution of Partnership approved by Securities Exchange Commission

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Frontline Services & Clientele

Documentary Requirements

PhilHealth Forms

Fee/s

Duration

d) Temporary suspension of operation due to: • Bankruptcy –  Financial Statement; or  Income Tax Return (ITR) for the year showing non-operation/no earnings • Fire/Demolition/Flood –  Certification from the Fire Department of the locality; or  Certification from the Municipal/City Hall • Strike –  Notice of Strike duly licensed by DOLE • Separation of employee/s  Report on the Separation of the Last Employee/s; and Separation paper of the last employee/s

e) Termination/Dissolution • Deed of Dissolution of Partnership approved by Securities Exchange Commission (SEC); and • Minutes of the Board Meeting duly certified by the Corporate Secretary

f) Merger/Consolidation • Deed of Merger/Merger Agreement duly approved by SEC; or • Memorandum of Agreement filed with SEC

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Frontline Services & Clientele

Documentary Requirements

PhilHealth Forms

Fee/s

Duration

g) Change of Ownership • Sale –  Deed of Sale/Transfer/Assignment signed by both parties  License to Operate (LTO) reflecting the name of the owner • Death of managing owner (Family Business) –  Death Certificate of the managing owner and waiver from the other legal heirs h) Resumption of Operation • Notice of Resumption of Operation from the employer, and • List of employees.

5.2.3 Corporation

a) Correction of business name • Certificate of Registration from SEC; or • Certificate of Articles of Partnership duly approved by SEC



ER3



No service fee



10 minutes

b) Change of business name • Certificate of Amended Articles of Incorporation duly approved by SEC c) Change of legal personality (Corporation to Partnership) • Certificate of Articles of Partnership duly approved by SEC; and • Deed of Dissolution as Corporation approved by SEC 22 | P a g e

Frontline Services & Clientele

Documentary Requirements

PhilHealth Forms

Fee/s

Duration

d) Temporary suspension of operation due to: • Bankruptcy –  Financial Statement; or  Income Tax Return (ITR) for the year showing non-operation/no earnings; or  Board Resolution certified by the Corporate Secretary • Fire/Demolition/Flood  Certification from the Fire Department of the locality; or  Certification from the Municipal/City Hall • Strike –  Notice of Strike duly licensed by DOLE • Separation of employee/s –  Report on the Separation of the Last Employee/s; and  Separation paper of the last employee/s

e) Termination/Dissolution • Deed of Dissolution approved by Securities Exchange Commission; and • Minutes of the Board Meeting duly certified by the Corporate Secretary f) Merger/Consolidation • Deed of Merger/Merger Agreement duly approved by SEC; or • Memorandum of Agreement filed with SEC

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Frontline Services & Clientele

Documentary Requirements

PhilHealth Forms

Fee/s

Duration

g) Change of ownership • Sale –  Deed of Sale/Transfer/Assignment signed by both parties  License to Operate (LTO) reflecting the name of Owner • Death of managing owner (Family Business) –  Death Certificate of the managing owner and waiver from the other legal heirs

h) Resumption of Operation • Notice of Resumption of Operation from the employer, and • List of employees 5.2.4 Cooperative

a) Correction of business name • Certificate of Registration from Cooperative Development Authority (CDA); or • Certificate of Articles of Cooperation duly approved by CDA



ER3



No service fee



10 minutes

b) Change of business name • Certificate of Amended Articles of Cooperation duly approved by CDA

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Frontline Services & Clientele

Documentary Requirements

PhilHealth Forms

Fee/s

Duration

c) Temporary suspension of operation due to: • Bankruptcy –  Financial Statement; or  Income Tax Return (ITR) for the year showing non-operation/no earnings; • Fire/Demolition/Flood –  Certification from the Fire Department of the locality; or  Certification from the Municipal/City Hall • Separation of employee/s –  Report on the Separation of the Last Employee/s; and  Separation paper of the last employee/s

d) Termination/Dissolution • Dissolution of Cooperation duly approved by CDA

e) Resumption of operation • Notice of Resumption of Operation from the employer, and • List of employees

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6.

Submission of application for accreditation Frontline Services &

Documentary Requirements

PhilHealth Forms

Fee/s

Duration

Clientele 6.1 Health Care Institutions (HCIs)

6.1.1 General requirements

1. 2.

3.

4.

5.

6.1.2 Specific requirements (to be submitted in addition to the general requirements

Properly accomplished Provider Data Record (PDR) Duly signed and properly filled out Performance Commitment (PC) applicable for single HCI or group of HCIs





Provider profile Record (properly accomplished) Performance Commitment



Refer to schedule of accreditation fees of HCI – Annex C



30 minutes

Electronic copies of recent photos (JPEG format) of the following required areas of the facility, taken within three months, to be submitted in CD or USB: a. Internal area - PhilHealth ward, ER, OR, RR, DR, ICU, if applicable) b. External – facade of the facility Statement of Intent (SOI). if applicable For hospitals and outpatient package providers applying for initial/re-accreditation from October to December of the current year on the validity of accreditation Latest audited financial statement/report (refer to A.1.a of PC 31, s2012) reflecting the income/payments received from PhilHealth (not required for Initial accreditation)

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Frontline Services &

Documentary Requirements

PhilHealth Forms

Fee/s

Duration

Clientele

1. Hospitals

1.

DOH license with validity applicable to the accreditation period applied for 2. Certificate of Accreditation issued by an ISQUAaccredited organization, if applicable 3. DOH licenses from 3 previous years or any of the following alternative document (only for initial accreditation): a. Supporting documents showing the Managing Health Care Professional’s(HC Professional) Education and Work experience such as: i. Certificate of completion of a masteral degree in hospital administration or other related degree; or ii. Any of the following proof of the work experience of the Managing HC Professional for three (3) years in a similar or analogous or at least the same level of accredited institution /facility it is applying for such as: • Service record from accredited government facility, or • Certification from the Board of the Corporation or Foundation, or • Certification from the Facility Owner of the private facility, or b. DOH LTO as Level 2 or 3 hospital ; or c. Certification from the LGU (signed by the LCE) that the LGU where the HCI operates cannot adequately or fully service its population; or d. Any proof that the HCI is an extension or branch of a HCI that has been accredited for at least 2 years such as: i. Securities & Exchange Commission (SEC) 27 | P a g e

Frontline Services &

Documentary Requirements

PhilHealth Forms

Fee/s

Duration

Clientele

Registration, including Articles of incorporation ii. Deed of Sale iii. Cooperative Development Authority (CDA) certificate iv. Dept of Trade Industry certificate (For private HCIs) 2. Ambulatory Surgical Clinic (ASC), Freestanding Dialysis Clinic (FSDC) and Primary Care Facility

1.

3. Primary Care Benefit Provider

1. Performance Commitment with specific provision for PCB 2. MOA with referral secondary laboratory for providers with no capability to provide lipid profile and FBS (sSigned by representative/s of the applicant HCI and referral facility ; name of the HCI and HCI representatives are reflected in the MOA; signatories in the MOA are also the signatories in the Performance Commitment): 3. Location map

4. Out-patient Malaria Package Provider

1. Certificate of Training in Malaria issued by DOH/CHDs 2. Any of the following proof that the staff is an employee of the applicant HCI, e.g. most recent payroll with the name of the staff in it or remittance form 1 or contract of service/service record

2.

DOH license with validity applicable to the accreditation period applied for DOH licenses from 3 previous years or its required alternative document for initial engagement of private clinics (same requirement as #3 of 1.1.2.1 above)

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Frontline Services &

Documentary Requirements

PhilHealth Forms

Fee/s

Duration

Clientele

5. Maternity Care Package Provider

1. Certificate of Compliance as a BEmONC facility (for automatic accreditation) 2. Certificate as Newborn Screening Facility or letter of approval as a Newborn screening facility (NSF) issued by the CHD or Newborn Screening Reference Center (NSRC) 3. Any of the following for applicable referral system:  MOA or Proof of Affiliation of the physician with at least a Level 1 PhilHealth accredited hospital  MOA with referral physician/s for OB and Pedia cases as applicable  MOA with a DOH-certified BEmONC - CEmONC network (if not BEmONC Certified) 4. Location map 5. Business Permit (for private facilities) 6. If the HCI will perform IUD insertion in the facility, submit the Certificate on “ Family Planning Competency Based Training ( FPCBT) Level 2 of the accredited Physician or Midwife who performs the IUD insertion, or Residency Training certificate on Obstetrics and Gynecology of the accredited physician

6. TB DOTS Package Providers

1. Updated DOH - PhilCAT Certificate 2. Location map

7. Animal Bite Treatment Package Provider

1. Certification as an Animal Bite Treatment Center (ABTC/ABC) from the DOH - National Rabies Prevention and Control Program Office 2. Location map 29 | P a g e

Frontline Services &

Documentary Requirements

PhilHealth Forms

Fee/s

Duration

Clientele

6.2 Health Care Professional (HC Professionals) 6.2.1 General 1. Properly accomplished PhilHealth application form 2. Duly notarized Warranties of Accreditation 3. 1 x 1 ID picture (2pcs) 4. PRC license, PRC claim stub or certification from PRC – updated 5. Proof of payment of required premium contributions (MI5 or Official Receipt or Certification from PhilHealth of Paid Premium Contributions or RF1 for the employed)





Application form for Accreditation of Health Care Professionals Warranties of Accreditation



30 minutes

6.2.1 Specific requirements (to be submitted by PHCP in addition to the general requirements) 1. Physicians i) General Practitioner

ii)

General Practitioner (with training)

Initial accreditation • TIN Card/BIR Form 2316 or certification issued by BIR indicating TIN Initial accreditation or re-accreditation due to upgrading/downgrading • TIN Card/BIR Form 2316 or certification issued by BIR indicating TIN – for initial accreditation only • Proof of completed residency training (local or abroad)

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Frontline Services &

Documentary Requirements

PhilHealth Forms

Fee/s

Duration

Clientele iii) Medical Specialist

2. Dentist

3. Midwife

Initial accreditation or re-accreditation due to upgrading • TIN Card/BIR Form 2316 or certification issued by BIR indicating TIN – for initial accreditation only • Philippine Specialty Board certificate  Initial accreditation • TIN Card/BIR Form 2316 or certification issued by BIR indicating TIN Initial accreditation •

TIN Card/BIR Form 2316 or certification issued by BIR indicating TIN • Any of the following evidences of Competency on the Expanded Functions of Midwives (not required for graduates from school year 1995 and onwards):  Certificate of Training from a program accredited by the Continuing Professional Education (CPE), Council of the Board of Midwifery of the Professional Regulation Commission (PRC); or  

Training Certificate from DOH-recognized training program; or Certificate of Apprenticeship for one or more years with a PHIC accredited ObstetricianGynecologist/OB DOH Specialist or an accredited midwife done in an accredited facility

31 | P a g e

Frontline Services &

Documentary Requirements

PhilHealth Forms

Fee/s

Duration

Clientele

For appreciation of witholding tax (not a pre-requisite for accreditation) • Certificate of Registration (for initial accreditation only) • Affidavit/Sworn Declaration of Current Year’s Gross Income (stamped received by BIR and shall be submitted every June 30 to July 22 of each year)

7. 1 Filing of Claims under Fee-For-Service and Case Rate (PhilHealth Circular No. 11, 11A and 11B, s.2011) Frontline Services & Clientele 7.1.1 Member (Direct filing)

Documentary Requirements • •

• • • • •

Hospital and doctor’s waiver and original official receipts of full payment Original official receipts or photocopies of the same authenticated by PHIC staff (with original copies seen) for medicines bought outside the hospital or laboratory tests performed outside the hospital during confinement  The authenticated photocopies is applicable in cases where original ORs are required by and submitted to HMOs Operative Record (if surgery was performed) Hospital Statement of Account duly signed by the hospital clerk or representative of the patient For Informal Economy members, latest Proof of Payment. For Indigents, Sponsored or Lifetime members, clear copy of PhilHealth ID Anesthesia and Surgical or Operative Record (if surgery

PhilHealth Forms •  



Claim Form 1 Claim Form 2 Claim Form 3/ Clinical Abstract (if necessary) (also mandatory for case payment) Member Data Record



Fee/s

Duration

No service fee

10 minutes per claim

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Frontline Services & Clientele

Documentary Requirements

• •

7. 1.2 HCP

PhilHealth Forms

Fee/s

Duration

was performed). Medical Certificate or Clinical Abstract indicating final diagnosis of patient, confinement period and services rendered written in English (if confined abroad) Additional requirements for confinements in nonaccredited health care institutions:  Health Care Institution’s DOH License  Clinical Abstract or CF3 indicating case was emergency and justification for impossibility of transferring patient to accredited health care institution.

Attached to claim • Operative Record with surgical technique (if surgery was performed) • Statement of Account (mandatory for fee-for-service only) • Original Official Receipts of medicines bought outside the hospital and x-ray/laboratory test performed outside the hospital during confinement* *X-ray/Laboratory results – mandatory for case payment From member • For Informal Economy members, latest Proof of Payment. • For Indigents, Sponsored or Lifetime members, clear copy of PhilHealth ID • Original Official Receipts of medicines bought outside the hospital or laboratory tests performed outside the hospital during confinement (if applicable)

• •

Claim Form 2 Claim Form 3 or Clinical Abstract (if required by policy)

30 minutes (for every 100 claims)

From member •

Claim Form 1



Member Data Record

33 | P a g e

7.2 Filing of All Case Rate Claims (PhilHealth Circular No. 35, s.2013) Frontline Services & Clientele 7.2.1 Member (Direct filing)

Documentary Requirements • •

• • • • •



Hospital and doctor’s waiver and original official receipts of full payment Original official receipts or photocopies of the same authenticated by PHIC staff (with original copies seen) for medicines bought outside the hospital or laboratory tests performed outside the hospital during confinement  The authenticated photocopies is applicable in cases where original ORs are required by and submitted to HMOs Hospital Statement of Account duly signed by the hospital clerk For Informal Economy members, latest Proof of Payment. For Indigents, Sponsored or Lifetime members, clear copy of PhilHealth ID Anesthesia and Surgical or Operative Record (if surgery was performed). For certain procedure listed in Annex No. 10 of PhilHealth Circular No. 35, s.2013, Doctor’s order, Nurse’s notes or official results shall be required. For confinements abroad:  Certification from the attending physician as to the final diagnosis, period of confinement and services rendered with English translations from hospital or Embassy for all documents.

PhilHealth Forms •

 



Claim Form 1 (this shall be the only form required for confinements abroad) Claim Form 2 Claim Form 3/Clinical Abstract (if necessary) Member Data Record, PhilHealth Benefit Eligibility Form or PhilHealth Cares Form 1.



Fee/s

Duration

No service fee

10 minutes per claim

34 | P a g e

Frontline Services & Clientele

7.2.2

Health Care Institution Filed Claims

Documentary Requirements  any proof of payment of hospital bills and professional fees from the HCI where the patient was confined. • Additional requirements for confinements in nonaccredited health care institutions:  Health Care Institution’s DOH License  Clinical Abstract or CF3 indicating case was emergency and justification for impossibility of transferring patient to accredited health care institution. Attached to claim • Operative Record with surgical technique (if surgery was performed). •

Original Official Receipts of medicines bought outside the hospital and x-ray/laboratory test performed outside the hospital during confinement.



Claims for TB DOTS Package shall have a copy of NTP Treatment Card in lieu of Claim Form 3.



For Animal Bite Treatment Package, providers may use Claims Summary Form attached as Annex B of PC 15, s 2012 instead of Claim Form 2. Moreover, submission of Claim Form 3 is not required.



Claims for Newborn Care Package shall have a copy of certificate of live birth. A copy from the facility without the registry number is acceptable as long as the records officer/clinic administrator of that facility certifies that it is the same copy which will be submitted for

PhilHealth Forms

• •

Claim Form 2 Claim Form 3 for Maternity Care Package and Primary Care Facilities

Fee/s

Duration

No service fee

30 minutes (for every 100 claims)

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Frontline Services & Clientele

Documentary Requirements

PhilHealth Forms

Fee/s

Duration

registration to local civil registrar. The Claim Form 2 shall have an attached filter collection card number of the NBS specimen. Also, Claim Form 3 is not required From member

• • •

Latest Proof of Payment (for Informal Economy members) Clear copy of PhilHealth ID (for Indigents, Sponsored or Lifetime members) Original Official Receipts of medicines bought outside the hospital or laboratory tests performed outside the hospital during confinement (if applicable)

From member

• •

Claim Form 1 Member Data Record

8. Submission of reports (manual) Frontline Services &

Documentary Requirements

PhilHealth Forms

Fee/s

Duration

Clientele 8.1 Employer (For non-EPRS employers only) 8.1.1 Hard copy RF1 users (employers with 10 and below employees)

• Employers Remittance Report (RF1) • PAR or POR • Bills Payments (from accredited collecting agents)

• RF1

• No service fee

• 10 minutes

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Frontline Services &

Documentary Requirements

PhilHealth Forms

Fee/s

Duration

Clientele 8.1.2 Soft copy RF1 users (employers with 11 and above employees)

• Textfile or MS Excel format Textfile • PAR or POR • Bills Payments (from accredited collecting agents)

• None

• No service fee

• 20 minutes

9. Request for records Frontline Services &

Documentary Requirements

PhilHealth Forms

Fee/s

Duration

Clientele 9.2 Employers

If through representative •

Authorization letter from the employer



Any valid ID of the representative



Request Form



No service fee

• 15 minutes

10. Check releasing Frontline Services &

Documentary Requirements

PhilHealth Forms

Fee/s

Duration

Clientele 10.1 All Members



10.2 Stakeholders





Photocopy of 2 valid IDs of the Member For authorized representative, authorization letter, photocopy of 2 valid IDs of the member and 2 valid IDs of the representative and/or SPA



None



No service fee



15 minutes

Valid identification of the authorized representative



None



No service fee



30 minutes

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F. Matrix of service standards (for frontline services) 1. Membership Registration 1.1 Employer Client Step

PhilHealth Action

Office/Person Responsible

Duration*

1. Secure information, membership registration form (ER1) and number at the Public Assistance Desk or Special Lane Section for PWDs/pregnant women. 2. Submit duly accomplished Employer Data Record (ER1 Form) and supporting documents once the number is called

1. Receive and screen duly accomplished ER1 Form together with supporting documents 2. Encode to MCIS 3. Print the Employer Data Record and Certificate of Registration 4. Release the Employer Data Record and Certificate of Registration

• Frontline Officer

• 20 minutes

3. Receive the Employer Data Record and Certificate of Registration

38 | P a g e

1.2.

Employees (Employed Sector)

Client Step 1. Secure information and/or number at the Public Assistance Desk or Special Lane Section for PWDs/pregnant women.

PhilHealth Action

Office/Person Responsible

2. Submit duly accomplished PMRF together with the Report of Employee-Members (Er2) and supporting documents once the number is called

1. Receive and screen duly accomplished PMRF, Er2 and supporting documents 2. Reconcile the name/s of the employees indicated in the Er2 form against the attached PMRF 3. Return received copy of Er2 (if submitted PMRFs are more than 5) or advise the client to wait for the release of PhilHealth Number Card (PNC) and Member Data Record (MDR) if submitted PMRFs are 5 and below at the Releasing Counter

• Frontline Officer

3. Receive advice and received copy of ER2 4. Endorse PMRFs to Support Officer for from the Frontline Officer if documents processing submitted are to be mailed or proceed to 5. Process PMRFs the Releasing Counter once the name of the Detailed Processing: company/business is called. 5.1 Verify if name of employee already exists in the system 5.2 Encode data indicated in the PMRF in the system 5.3 Print PhilHealth Number Cards (PNC) and Member Data Record (MDR) 6. Release the Philhealth Number Card/s (PNC) and Member Data Record/s (MDR)

• Frontline Officer

Duration

• 25 minutes (for 5 PMRFs and below) • 10 working days for 6 PMRFs and above

• Support Officer

39 | P a g e

Client Step 4. Receive copy of PNC and MDR at the Releasing Counter

PhilHealth Action

Office/Person Responsible

Duration

PhilHealth Action

Office/Person Responsible

Duration

1.3 Lifetime Members Client Step 1. Secure information, PhilHealth Member Registration Form (PMRF) and number at the Special Lane Section. 2. Submit duly accomplished PMRF and supporting document, if applicable, once the number is called.

1. Receive and screen duly accomplished PMRF with supporting documents



Frontline Officer



30 minutes

2. Encode/assign/update member data and scan signature of member 3. Print the Member Data Record (MDR) and Identification Card

3. Sign name in the PhilHealth ID card

4. Laminate the printed Identification Card with the ID picture of the Client/Member 5. Release the laminated Identification Card to Client/Member together with the Member Data Record (MDR) and have the member sign/acknowledge receipt of documents

4. Receive the Identification Card and Member Data Record (MDR) and acknowledge receipt

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2. Membership Enrollment 2.1 Informal Sector formerly known as Individually Paying Members ClientStep PhilHealth Action

Office/Person Responsible

Duration

1. Secure information, PhilHealth Member Registration Form (PMRF) and number at the Public Assistance Desk or Special Lane Section for PWDs/pregnant women. 2. Submit duly accomplished PMRF and supporting documents and payment slip once the number is called.

1. Receive and screen duly accomplished PMRF with supporting documents



Frontline Officer



10 minutes



Payment processor/Collecting Officer



5 minutes



Collecting Officer



5 minutes

2. Evaluate the completeness of data in the PMRF 3. Encode/assign/update in the MCIS 4. Print the Member data Record (MDR) and PhilHealth Identification Card (PNC) of the Client/Member 5. Endorse payment slip to the assigned payment processor and advise to proceed to the Payment Processor window and return after payment has been made

3. Proceed to the Cashier’s window once number is called, tender payment (premium contribution) and receive Official Receipt

6. Encode payment slip and assign number

4. Proceed to Frontline Officer and receive PNC and MDR

8. Receive payment from client, print Official Receipt (OR) and issue OR

7. Advise member to proceed to Cashier’s Window once the number is called

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2.2 Migrant Workers (Land-based) Client Step 1. Secure information, PhilHealth Member Registration Form (PMRF) and number at the Public Assistance Desk or Special Lane Section for PWDs/pregnant women. 2. Submit duly accomplished PMRF and payment slip once the number is called.

PhilHealth Action

Office/Person Responsible

Duration*

1. Receive and screen duly accomplished PMRF with supporting documents and payment slip 2. Encode/assign/update member’s data 3. Endorse payment slip to the assigned Payment Processor/Collecting Officer and advise client to proceed to the Payment Processor window and return after payment has been made



Frontline Officer



10 minutes

3. Proceed to the Payment Processor desk and receive priority number

4. Encode payment slip and assign number 5. Advise member to proceed to Cashier’s Window once the number is called



Payment Processor/ Collecting Officer



5 minutes

4. Proceed to the Cashier’s window once number is called, tender payment (premium contribution) and receive Official Receipt

6. Receive payment, issue OR and advice client/member to proceed to Frontline Officer to get PhilHealth Number Card (PNC) / Member Data Record (MDR)



Collecting Officer



5 minutes

7. Print and release MDR and PNC



Frontline Officer

5. Receive PNC and MDR from Frontline Officer

42 | P a g e

3. Updating of membership records

Client Step 1. Secure information, PhilHealth Member Registration Form (PMRF) and number at the Public Assistance Desk • Special Lane for PWDs, Pregnant Women and Senior Citizens 2. Submit duly accomplished PhilHealth Member Registration Form (PMRF)/ER3 and supporting documents once number is called

PhilHealthAction

1. Receive and screen duly accomplished PMRF with supporting documents 2. Encode/update Client/Member’s data 3. Print amended Member Data Record (MDR)/ PhilHealth Identification Card (PIC- if applicable) 4. Release amended MDR/PIC (if applicable) to the member or Employer Data Record (EDR) to the employer

Office/PersonResponsible

• Frontline Officer

Duration*

• 15 minutes per PMRF

3. Receive updated MDR/PIC (if applicable)/EDR *Under normal circumstances per transaction

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4. Request for records (MDR, Certificates, PIC, CE1)

Client Step

PhilHealth Action

Office/Person Responsible

Duration*

1. Secure information, number and request for documents form at the Public Assistance Desk 2. Submit duly accomplished request for documents form (with supporting documents if applicable) once number is called

1. Receive properly filled up request form w ith supporting documents (if applicable) 2. Process request of client 3. Release requested documents and require member to acknowledge receipt of documents

• Frontline Officer

• 15 minutes per requested form/ document

3. Receive requested document and acknowledge receipt *Under normal circumstances per transaction

44 | P a g e

5. Payment of premium contributions

Client Step 1. Secure PPPS at the Public Assistance Desk and secure number if applicable

PhilHealth Action

Person Responsible

Duration*

2. Fill out PPPS 3. Submit payment slip to the Payment Processor

1. Receive and encode payment slip, assign number if applicable and advise Client/Member to proceed to the cashier’s counter once number is called

• Payment Processor

4. Proceed to Cashier's window and tender payment once priority number is called

2. Receive money from the Client/Member and print Official Receipt(OR) 3. Release/issue PhilHealth Official Receipt Note: LHIOs may combine all PhilHealth actions

• Collecting Officer

• 10 minutes

5. Receive PhilHealth Official Receipt *Under normal circumstances per transaction

45 | P a g e

6.

Inquiry/public assistance

Client Step • Proceed to the Public Assistance Desk/Corner and ask for information.

7.









PhilHealth Action • Accommodate client’s inquiry

Office/Person Responsible • Frontline Officer

Duration • 8 minutes

Office/Person Responsible • Public Assistance Staff

Duration * 1 minute

Filing of claims by Health Care Institutions (HCI) Client Step Secure information and/or priority number at the Public Assistance Desk When priority number is called, proceed to Frontline Service Counter and submit claims together with the transmittal list Affix initials to copy of transmittal list, if with correction.

Receive copy of acknowledged transmittal list

• • •





PhilHealth Action Direct client/s to the appropriate front line service. Provide the priority number to client/s. Receive and screen claims as to the correct number and names of claimants against transmittal list.



Frontline Officer





30 minutes for every 100 claims

Stamp “received” on the transmittal list if there are no deficiencies in the transmittal and total number of claim; if there is/are name/s listed but no claims attached, cross-out name/s in the list and have the transmittal list initialed by the hospital representative/health care provider. Return received copy of transmittal list to hospital representative/health care provider and advise client that processing of claims will be done within the 60-day period

*Under normal circumstances per transaction

46 | P a g e









Filing of claims (Direct-filing by members) Client Step Secure information and/or priority number at the Public Assistance Desk When priority number is called, submit duly accomplished acknowledgement receipt form, PhilHealth claims with supporting documents once priority number is called Receive acknowledgement receipt or claim with deficiency

• • • •



PhilHealth Action Office/Person Responsible Direct client/s to the appropriate front line • Public Assistance Staff service. Provide the priority number to client/s. Receive and screen claims as to completeness • Frontline Officer of documentary requirements (non-medical). Stamp “received” the acknowledgement receipt form and return copy to client/member or return acknowledgement receipt and PhilHealth claim if with deficiency for client/member’s compliance. Advise Client/Member to expect notice/Benefit Payment Notice (BPN) (within the 60-day period) or to comply with the required/deficient documents/information.



Duration * 1 minute



10 minutes

*Under normal circumstances per transaction

47 | P a g e

9.

Submission of remittance reports (RF1)

Client Step 1. Secure information and/or number if applicable a the Public Assistance Desk

PhilHealth Action

2. Submit remittance report (RF-1) and/or diskette/flashdrive once number is called

1. Receive and screen remittance report (as to number and/or data stored in the diskette/flash drive). 2. Stamp “received” on the remittance report 3. Return received copy of remittance report/flash drive to client.

Office/Person Responsible

• Frontline Officer

Duration*

• 20 minutes (every 50 pages) • 30 minutes (soft copy)

3. Receive copy of acknowledged remittance report *Under normal circumstances per transaction

10. Submission of application for accreditation of Health Care Institution (HCI) Client Step PhilHealth Action 1. Secure priority number and information and payment slip at the Public Assistance Desk 2. Submit duly accomplished 1. Receive Provider Data Record (PDR), other application forms for accreditation accreditation documentary requirements and and supporting documents together payment slip (order of payment) with the properly-filled -out 1. Screen application and other documentary payment slip once priority number is requirements as to completeness of called requirements 2. Write down the HCI data in the receiving logbook

Office/Person Responsible



Frontline Officer

Duration*

4. 30 minutes

48 | P a g e

Client Step 3. If the application is not complete, get the receiving copy of the application, receive deficiency letter and explanation on the content of the letter and sign under “disposition” column in the receiving logbook

4. Proceed to Cashier 5. Proceed to frontline service counter and get receiving copy of the PDR and other requirements.

PhilHealth Action 3.

Office/Person Responsible

Duration*

If the application is not complete, return the application to the HCI, furnish a Deficiency Letter, explain the content of the deficiency letter and ask HCI representative to sign under “disposition” column in the receiving logbook

5. If the application is complete, stamp complete

the file copy and the receiving copy (PDR and the 1st page of the other requirements) 6. Endorse payment slip (order of payment) to client and advice to proceed to the Payment Processor window and return after payment has been made. 7. Receive payment for accreditation of the HCI, print and release Official Receipt 8. Release the receiving copy of the PDR and other

requirements to the HCI representative 9. If LHIO has an integrated PhilHealth Accreditation System ( iPAS) , they will encode the following HCI data in the receiving module of IPAS a. Name of HCI b. Address c. Date of submission d. OR number e. Amount of payment f. Date of Payment g. Manner of submission h. Documents submitted



Collecting Officer



Frontline Officer

*Under normal circumstances per transaction 49 | P a g e

11. Submission of application for accreditation Health Care Professionals (HC Professional) Client Step 1. Secure priority number and information and payment slip at the Public Assistance Desk 2. Submit duly accomplished application form for accreditation and supporting documents

PhilHealth Action

1. 2. 3.

3. If the application is not complete, get the application and all other requirements, receive the deficiency letter and sign under “disposition” column in the receiving logbook

4.

4. If the application is complete, get the receiving copy of all the requirements and receipt of payment.

5.

6. 7.

Receive application for accreditation, and other supporting documents Screen as to completeness of requirements Write down the HC Professional data in the recceiving logbook If the application is not complete, return the application to the HCI, furnish Deficiency Letter, explain content of deficiency letter and ask HCI representative to sign under “disposition” column in the receiving logbook

Office/Person Responsible



Frontline Officer

Duration*

30 minutes

If the application is complete, stamp complete the file copy and receiving copy of the application and the 1st page of the other requirements. Release receiving copy of the application to the HCI applicant If LHIO has iPAS, encode the following HCI data in the receiving module of IPAS a. Name of HC Professional b. Address c. Date of submission d. Manner of submission e. Documents submitted

*Under normal circumstances per transaction

50 | P a g e

12. Check releasing (pick-up by member) Client Step 1. Secure priority number at the Public Assistance Desk if applicable 2. Present valid IDs once number is called at the Check Releasing Counter/Cashier’s window

PhilHealth Action

1. Verify if claim check is available, if not, advice client/member of status of the check( if not yet available etc.) 2. Validate IDs presented if check is available and Release to client/member. 3. Require member to acknowledge receipt of the check thru the logbook.

Office/Person Responsible

• Frontline Officer

Duration*

• 15 minutes

3. Acknowledge receipt of check. *Under normal circumstances per transaction 13. Check releasing (pick-up by stakeholders)

Client Step 1. Secure number at the Public Assistance Desk if applicable

PhilHealth Action

2. Present valid company IDs once 1. Receive and validate company ID priority number is called at the Check Releasing Counter/Cashier’s window 3. Countercheck/validate cheques received then acknowledge receipt of check, affix signature in the logbook and disbursement voucher

Office/Person Responsible

• Frontline Officer

Duration*

• 30 minutes

2. Verify if check is available, if not, advice client of status of the check, if check is available release check to client. 51 | P a g e

Client Step

PhilHealth Action

Office/Person Responsible

Duration*

3. Require client to acknowledge receipt of the check thru the logbook and disbursement voucher. 4. Issue official receipt 4. Receive the official receipt and file *Under normal circumstances per transaction

14. Request for other services

Client Step PhilHealth Action Office/Person Responsible Duration* Other services include: (a) Replacement of check; (b) Adjustment of benefit payment; (c) Adjustment of premium contribution; (d) Filing of complaints against health providers/professionals; and (e) Walk-inquiries 1. Secure priority number, information and applicable forms at the Public Assistance Desk 2. Submit duly accomplished forms and supporting documents (if applicable) once priority number is called 1. Receive request form/applicable forms 2. Check/Evaluate documents received. 3. Provide feedback on requested service; advise member/stakeholder appropriately 4. Ask member/stakeholder to affix signature in logbook to acknowledge filing of request

• Frontline Officer

15 minutes per transaction

52 | P a g e

Client Step 3. Acknowledge receipt of document requested and/or advice and affix signature in the logbook

PhilHealth Action

Office/Person Responsible

Duration*

*Under normal circumstances per transaction

15. Feedback mechanism

Client Step 1. Proceed to the LHIO Head

PhilHealth Action 1. Accommodate/handle client’s concern/s 2. Provide feedback and/or resolve the client’s concern 3. Advise/Assist client to fill up feedback form (if necessary) 4. Politely close the conversation 5. Record the transaction

2. Fill out feedback form

6. Retrieve the feedback form in the feedback box daily and record and resolve the issues in the feedback form 7. Refer to the appropriate office

3. Awaiting feedback

8. Provide feedback if necessary

Office/Person Responsible • Local Health Insurance Office (LHIO) Head

Duration* • 20 minutes

Daily

Concerned Office

Within 10 calendar days upon receipt

``

53 | P a g e

G. Process Flow Chart

54 | P a g e

H. Feedback and Redress Mechanism

PhilHealth provides a Feedback/ Suggestion Box to its Local Health Insurance Offices wherein clients may drop the accomplished Client Feedback Form available thereat. The said box will be opened and checked daily for content(s), if any. You can also visit our website, www.philhealth.gov.ph to download

forms

or

our

social

media

accounts,

www.facebook.com/PhilHealth

Thank you.

Client Feedback Form

and

www.twitter.com/teamphilhealth for online feedback.

You can also talk anytime to our Officer-of-the-Day for assistance regarding our Client Feedback Form. We value your feedback for better service. Name: All feedback will be promptly acknowledged and any complaint/ grievance that requires action will be undertaken

Address:

and communicated within 30 working days from receipt of the same.

Phone Number: Email CityState Centre Bldg.,

Your Satisfaction is our Fulfillment

709 Shaw Blvd., Brgy. Oranbo, Pasig City Phone: 02-4417442

Address: Office Address:

Email: [email protected]

55 | P a g e

E. F. G.

Client Feedback Form

Service being complained:

Please check the appropriate box.

Suggestions to improve our service:

Are you satisfied with our service? Yes

No Office:

Reason: Name/Position of staff who rendered service:

When did it happen? Commendation for services or staff Complaint about our services or staff

Facts of complaint:

Please use additional sheet if necessary

Suggestions to improve our services Service/employee being commended: What is your desired action from our office? Office/Position:

Name: Signature:

Reason for commendation: Date:

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I. Anti-Fixer Campaign Banner

57 | P a g e

J. Anti-Fixer Calling Card 3.5 inches

2 inches

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Annex A Table 1. Premium Contribution Table for the Formal Economy including sea-based employees and Kasambahay (January to December 2014 only per PC 57, s2012) Salary

Salary Range

Salary Base

1

8,999.99 and below

8,000.00

2

9,000.00-9,999.99

3

Total Monthly

Employee Share*

Employer Share

200.00

100.00

100.00

9,000.00

225.00

112.50

112.50

10,000.00-10,999.99

10,000.00

250.00

125.00

125.00

4

11,000.00-11,999.99

11,000.00

275.00

137.50

137.50

5

12,000.00-12,999.99

12,000.00

300.00

150.00

150.00

6

13,000.00-13,999.99

13,000.00

325.00

162.50

162.50

7

14,000.00-14,999.99

14,000.00

350.00

175.00

175.00

8

15,000.00-15,999.99

15,000.00

375.00

187.50

187.50

9

16,000.00-16,999.99

16,000.00

400.00

200.00

200.00

10

17,000.00-17,999.99

17,000.00

425.00

212.50

212.50

11

18,000.00-18,999.99

18,000.00

450.00

225.00

225.00

12

19,000.00-19,999.99

19,000.00

475.00

237.50

237.50

13

20,000.00-20,999.99

20,000.00

500.00

250.00

250.00

14

21,000.00-21,999.99

21,000.00

525.00

262.50

262.50

15

22,000.00-22,999.99

22,000.00

550.00

275.00

275.00

16

23,000.00-23,999.99

23,000.00

575.00

287.50

287.50

17

24,000.00-24,999.99

24,000.00

600.00

300.00

300.00

18

25,000.00-25,999.99

25,000.00

625.00

312.50

312.50

19

26,000.00-26,999.99

26,000.00

650.00

325.00

325.00

Bracket

Premium

59 | P a g e

Salary

Salary Range

Salary Base

20

27,000.00-27,999.99

27,000.00

21

28,000.00-28,999.99

22

Total Monthly

Employee Share*

Employer Share

675.00

337.50

337.50

28,000.00

700.00

350.00

350.00

29,000.00-29,999.99

29,000.00

725.00

362.50

362.50

23

30,000.00-30,999.99

30,000.00

750.00

375.00

375.00

24

31,000.00-31,999.99

31,000.00

775.00

387.50

387.50

25

32,000.00-32,999.99

32,000.00

800.00

400.00

400.00

26

33,000.00-33,999.99

33,000.00

825.00

412.50

412.50

27

34,000.00-34,999.99

34,000.00

850.00

425.00

425.00

28

35,000.00 and up

35,000.00

875.00

437.50

437.50

Bracket

Premium

*Employee share represents half of the total monthly premium while the other half is shouldered by the employer.

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Annex B

Table 2. Premium Contribution Table for the Informal Economy /Sponsored Members Self Earning Individuals

3,600/annum

Informal members with income P25,000 and below

2,400/annum

Sponsored Members

2,400/annum

Table 3. Premium Contribution Table for Migrant Workers Land-based

2,400/annum

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Table 4. Schedule of Accreditation Fee for Health Care Institutions INSTITUTIONS

INITIAL, CONTINUOUS/ RE-ACCREDITATION (PRIVATE/GOVERNMENT)

Level III Hospitals (teaching Hospitals)

P 10,000.00

Level II Hospitals

P 8,000.00

Level I Hospitals

P 5,000.00

Primary Care Facility (Infirmary/Dispensary) Specialty Hospital

P 3,000 Based on the service Capability of the hospital

Ambulatory Surgical Centers (ASCs)

P 5,000.00

Free Standing Dialysis Centers (FDCs)- HD and PD

P 5,000.00

Primary Care Benefit Providers (PCB)

P 1,000.00

TB-DOTS Provider

P 1,000.00

Non-Hospital Maternity Care Providers

P 1,500.00

PCB (OPB) and DOTS Providers

P 1,000.00

PCB (OPB) and MCP Providers

P 1,500.00

PCB, DOTS and MCP Providers MCP and DOTS Providers Animal Bite Package Providers

Annex C

P 1,500 P 1,500.00 P 1,000

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